High Blood Sugar
There are times when your blood glucose levels may go too high. High levels are most likely when you are sick or under a lot of stress. When your blood sugar level is too high, you may:

• Have a headache.
• Have blurry vision.
• Feel thirsty and need to go to the bathroom often.
• Have dry, itchy skin.

High sugar can make you very dehydrated. Those who suffer from this syndrome are older people with type 2 diabetes. Be sure to drink lots of water when you are sick or have high blood sugar.

Low Blood Sugar
Sometimes your blood sugar level can fall too low. These levels are most likely caused by taking insulin or some diabetes pills. It can also be caused by: taking too many diabetes medicine, eating too little or not eating. Exercising too hard or too long, drinking alcohol without eating. If your blood glucose is getting too low, you may feel:

• Shaky.
• Tired.
• Hungry.
• Confused.
• Nervous.

Ketoacidosis
If your sugars go too high, ketones may build up in the blood. These waste products then poison the blood. This problem occurs most often in people with type 1 diabetes. You should check your urine for ketones when you have symptoms of high blood sugar, have blood sugar over 300 mg/dl, are sick. Call your doctor if your blood sugar is high and your urine has ketones.

Kidney Disease
Kidney disease, or nephropathy, is a frequent complication of diabetes, both type 1 and type 2, and often ends in kidney failure, or end–stage renal disease. Ten to twenty–one percent of all people with diabetes have nephropathy. The single most common cause of end–stage renal disease is diabetic nephropathy. The key to preventing diabetes–related kidney problems begins with good control of blood glucose levels, control of blood pressure and regular screening by a health care professional.

Eye Disease
Vision impairment is a frequent complication of diabetes, both type 1 and type 2. The major cause of blindness in people with diabetes is diabetic retinopathy. Nearly all patients who have type 1 diabetes for about 20 years will have evidence of diabetic retinopathy.

Hypoglycemia
Intensive insulin control increases the risk of hypoglycemia (also called insulin shock), which occurs if blood glucose levels fall below normal. Hypoglycemia may also be caused by insufficient intake of food, exercise, or alcohol. Usually the condition is manageable, but occasionally, it can be severe or even life threatening, particularly if the patient fails to recognize the symptoms.

Mild symptoms usually occur at moderately low and easily correctable levels of blood glucose, they include sweating, trembling, hunger, and rapid heartbeat. Severely low blood glucose levels can precipitate neurologic symptoms: confusion, weakness, disorientation, combativeness, and in rare and worst cases, coma, seizure, and death. Patients who experience repeated episodes of hypoglycemia may become insensitive to symptoms, even a single recent episode of hypoglycemia may make it more difficult to detect the next episode. By rigorously avoiding low blood glucose, such patients can regain the ability to sense the symptoms. Patients are at highest risk for hypoglycemia at night. Bedtime snacks may be helpful. Most experts recommend that patients monitor blood levels as often as possible, four times or more per day. This is particularly important for patients who have a history of experiencing no symptoms of hypoglycemics before mental changes occur.

Diabetic patients on therapies that put them at risk for hypoglycemia should always carry hard candy, juice, or sugar packets. Family and friends should be aware of the symptoms. If the patient is helpless, they should administer three to five pieces of hard candy, two to three packets of sugar, or half a cup (four ounces) of fruit juice. If there is inadequate response within 15 minutes, additional oral sugar should be provided or the patient should receive emergency medical treatment including the intravenous administration of glucose. Family members and friends can learn to inject glucagons, a hormone, which, unlike insulin, raises blood glucose.

Cardiovascular Complications
Heart attacks account for 60% and strokes for 25% of deaths in all diabetes. Long–term insulin resistance, appears to have significant damaging effects on the heart, including contributing to very unhealthy cholesterol and lipid balances blood clotting problems, and high blood pressure.

Neuropathy, Vascular Injury, and Amputations
Neuropathy is decreased or distorted nerve function, it particularly affects sensation. Symptoms include numbness, tingling, weakness, and burning sensations. Fingers and toes and moving up to the arms and legs (called a glove and stocking distribution). If the nerves are damaged as well, the person may be unaware that even a blister or minor wound has become infected. The problem is compounded in diabetes because of circulatory problems resulting from blood vessel injury, which may be severe enough to cause tissue damage in the legs and feet. Even minor infections can develop into deep tissue injury. Extensive surgery may be required, and, in extreme cases, amputation of the foot or leg may be necessary.

If diabetes affects the nerves in the autonomic nervous system, then abnormalities of blood pressure control, bowel and bladder function, and male sexual function can also occur. In some cases, neuropathy may block angina, the warning chest pain for heart disease and heart attack. Diabetic patients should be aware of other warning signs of a heart attack, including sudden fatigue, sweating shortness of breath, nausea and vomiting.

Mental Function and Dementia
Patients with type 2 diabetes, higher than average has the risk of developing dementia. Problems in attention and memory can occur in people under 55 who have had diabetes for a number of years.

Complications in Pregnancy
Because glucose crosses the placenta, a woman with diabetes can pass high levels of blood glucose to the fetus. In response, the fetus secretes large amounts of insulin. This combination of high fetal blood levels of insulin and glucose leads to excessive fetal growth. It may also contribute to delayed maturation of the lungs or to the death of the fetus.